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The opinions within this web page are not ours. Authors have been credited
for the individual posts where they are. Photos courtesy Rajiv Patel - ROOTS
  Forked tongue cases!

From: Rajiv Patel
Sent: Saturday, June 20, 2009 5:48 PM
Subject: [roots] Forked tongue cases!

Had 2 in a week with these forked apical splits. Had to squirt 
the Db canal on the maxillary molar - while hand instrumentation 
could sense multiple apical picks during recaps.
The mandibular molar was reasonably easier...(; -  Rajiv Patel

Forgot to add this from the same week - 3 visits on a premolar with a deep split. Some times you gotta use your finger (seen in radiograph) to get a decent rad. This fine lady was missing her canines and had a shallow palate - any suggestions for getting better radiographs on these without being in the line of fire?? - Rajiv

Rajiv,'the way to get off line of fire is to push somebody else in there :-) Usually it could be..guess who?... the patient :-) - Dmitri Superb! - RafaŽl beautiful work Rajiv - Imran Hi Rajiv, Beautiful work as usual ! Do your referrals have a problem with you doing the permanent restoration? I still have your presentation on "coronal seal" :-))) - Siju Thanks Siju. You are right Siju - there are some referrrals who have a preference to place the permanent restoration. We have a list of referrals who want us to place the seal. It can be a very sensitive topic to broach...but as endodontists we are known to get on other people's NERVES... (; - Rajiv Very Nice. What radiography system do you use? - Roman Bakowicz It's a Schick system. Thanks for your comments - Rajiv Dr.Patel: Wonderfull shapings. Could you describe for us your instrument sequence for the mesials canals of the treated first inferior molar? - Laura Thanks Laura. Here is my not so fancy instrumentation - Shaping and cleaning not so rigid regimen: 1. Checking /Scouting for canal curvatures with small hand files -6,8,10 2. Use hand instruments in a crown down manner - makes it easy for smaller files to gain length easily 3. Gates - 3 & 2 mainly and occassionally 4 4. Create a glide path to atleast a 20 with hand files prior to using a rotary - I use Protapers and Profiles and supplement with them patency files after every rotary use to maintain patency- Lots of irrigation and at times Endoactivator to activate irrigation 5. In severe apical curves - prebending your files helps a lot, in some cases I do use the reciprocating hand piece - not this one! The main TIP is TIME, INTENTION + PATIENCE - Rajiv Patel Dear Dr. Patel: Thanks to you very much for your response. Two more questions please: 1.- I would like to know if you use the rotatory Protapers or Profiles only in a rotational way or sometimes you use them with a reciprocating handpiece, like M4 or Endo Eze. 2.- Safe prebending the files: Do you use prebend in this case: Flexo-files, K-files, Niti-files and till what number of files: 25, 30 ? Also Protapers or Profiles? - Laura Hi Laura, I haven't tried using Protapers in a reciprocating handpiece....may be I am missing out..(: I do use them sometimes for hand instrumentation and prebend them if necessary. And to your 2nd question - I do pre-bend K- files keeping in mind the previous curvatures obtained from the "scouters" - smaller files (6,8,10..) Again in tight curves - it will take repeated pre-bending to maintain the curvatures. Sometimes in these tight/acute curvatures - my experience is that there is a compromise if your intention is to obtain large apical sizes - you risk altering the anatomy. Hence it will be case to case with respect to apical size - Rajiv Patel Hey Kendo, Yes - 3.7/ # 18 has been treatment planned for sunshine and cold steel due to a all the signs of a crack .The patient and the referral are both aware of it, the patient wanted to wait untill 4th of July fireworks for the extraction.....);. - Rajiv I love the cases and the TIP too, Rajiv - Nuria

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